Gisèle Pickering1, Bruno Pereira, Véronique Morel, Alexandrine Corriger, Fatiha Giron, Fabienne Marcaillou, Assiya Bidar-Beauvallot, Evelyne Chandeze, Céline Lambert, Lise Bernard, Noémie Delage. 1. From University Hospital Clermont-Ferrand, Inserm CIC 1405, Clinical Pharmacology Department, F-63000 Clermont-Ferrand, France (G.P., V.M., A.C., F.G.) Clermont Auvergne University, Inserm 1107, F-63000 Clermont-Ferrand, France (G.P.) University Hospital Clermont-Ferrand, Clinical Research and Innovation Department, F-63000 Clermont-Ferrand, France (B.P., C.L.) University Hospital of Clermont-Ferrand, Assessment and Treatment of Pain Center, F-63000 Clermont-Ferrand, France (F.M., A.B.-B., E.C., N.D.) University Hospital Clermont-Ferrand, Clinical Research/Temporary Authorization Department, F-63000 Clermont-Ferrand, France (L.B.).
Abstract
BACKGROUND:Ketamine is often used for the management of refractory chronic pain. There is, however, a paucity of trials exploring its analgesic effect several weeks after intravenous administration or in association with magnesium. The authors hypothesized that ketamine in neuropathic pain may provide pain relief and cognitive-emotional benefit versus placebo and that a combination with magnesium may have an additive effect for 5 weeks. METHODS: A randomized, double-blind, crossover, placebo-controlled study (NCT02467517) included 20 patients with neuropathic pain. Each ketamine-naïve patient received one infusion every 35 days in a random order: ketamine (0.5 mg/kg)/placebo or ketamine (0.5 mg/kg)/magnesium sulfate (3g) or placebo/placebo.The primary endpoint was the area under the curve of daily pain intensity for a period of 35 days after infusion. Secondary endpoints included pain (at 7, 15, 21 and 28 days) and health-related, emotional, sleep, and quality of life questionnaires. RESULTS:Daily pain intensity was not significantly different between the three groups (n = 20) over 35 days (mean area under the curve = 185 ± 100, 196 ± 92, and 187 ± 90 pain score-days forketamine, ketamine/magnesium, and placebo, respectively, P = 0.296). The effect size of the main endpoint was -0.2 (95% CI [-0.6 to 0.3]; P = 0.425) for ketamine versus placebo, 0.2 (95% CI [-0.3 to 0.6]; P = 0.445) for placebo versus ketamine/magnesium and -0.4 (95% CI [-0.8 to 0.1]; P = 0.119) for ketamine versus ketamine/magnesium. There were no significant differences in emotional, sleep, and quality of life measures. During placebo, ketamine, and ketamine/magnesium infusions, 10%, 20%, and 35% of patients respectively reported at least one adverse event. CONCLUSIONS: The results of this trial in neuropathic pain refuted the hypothesis that ketamine provided pain relief at 5 weeks and cognitive-emotional benefit versus placebo and that a combination with magnesium had any additional analgesic effect.
RCT Entities:
BACKGROUND:Ketamine is often used for the management of refractory chronic pain. There is, however, a paucity of trials exploring its analgesic effect several weeks after intravenous administration or in association with magnesium. The authors hypothesized that ketamine in neuropathic pain may provide pain relief and cognitive-emotional benefit versus placebo and that a combination with magnesium may have an additive effect for 5 weeks. METHODS: A randomized, double-blind, crossover, placebo-controlled study (NCT02467517) included 20 patients with neuropathic pain. Each ketamine-naïve patient received one infusion every 35 days in a random order: ketamine (0.5 mg/kg)/placebo or ketamine (0.5 mg/kg)/magnesium sulfate (3g) or placebo/placebo.The primary endpoint was the area under the curve of daily pain intensity for a period of 35 days after infusion. Secondary endpoints included pain (at 7, 15, 21 and 28 days) and health-related, emotional, sleep, and quality of life questionnaires. RESULTS: Daily pain intensity was not significantly different between the three groups (n = 20) over 35 days (mean area under the curve = 185 ± 100, 196 ± 92, and 187 ± 90 pain score-days for ketamine, ketamine/magnesium, and placebo, respectively, P = 0.296). The effect size of the main endpoint was -0.2 (95% CI [-0.6 to 0.3]; P = 0.425) for ketamine versus placebo, 0.2 (95% CI [-0.3 to 0.6]; P = 0.445) for placebo versus ketamine/magnesium and -0.4 (95% CI [-0.8 to 0.1]; P = 0.119) for ketamine versus ketamine/magnesium. There were no significant differences in emotional, sleep, and quality of life measures. During placebo, ketamine, and ketamine/magnesium infusions, 10%, 20%, and 35% of patients respectively reported at least one adverse event. CONCLUSIONS: The results of this trial in neuropathic pain refuted the hypothesis that ketamine provided pain relief at 5 weeks and cognitive-emotional benefit versus placebo and that a combination with magnesium had any additional analgesic effect.
Authors: Jacob E Israel; Samantha St Pierre; Emily Ellis; Josephine S Hanukaai; Nazir Noor; Giustino Varrassi; Markus Wells; Alan D Kaye Journal: Health Psychol Res Date: 2021-07-10
Authors: Eric S Schwenk; Basant Pradhan; Rohit Nalamasu; Lucas Stolle; Irving W Wainer; Michael Cirullo; Alexander Olsen; Joseph V Pergolizzi; Marc C Torjman; Eugene R Viscusi Journal: Curr Pain Headache Rep Date: 2021-07-16
Authors: Ivan Urits; Jai Won Jung; Ariunzaya Amgalan; Luc Fortier; Anthony Anya; Brendan Wesp; Vwaire Orhurhu; Elyse M Cornett; Alan D Kaye; Farnad Imani; Giustino Varrassi; Henry Liu; Omar Viswanath Journal: Anesth Pain Med Date: 2021-02-06